1. Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms
- Author
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Beniamino Nannavecchia, J. Todeschi, Rodolfo Maduri, Francis Turjman, Paolo Gallinaro, Helene Cebula, Francesco Signorelli, Rémy Beaujeux, Antonino Scibilia, Mario Ganau, Salvatore Chibarro, François Severac, Raoul Pop, Etienne Lefevre, Hugo Andres Coca, Ismail Zaed, and François Proust
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Treatment outcome ,Neurosurgical Procedures ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Oculomotor Nerve Diseases ,medicine ,Humans ,Prospective Studies ,Posterior communicating artery ,Embolization ,Oculomotor nerve palsy ,Surgical treatment ,Aged ,Retrospective Studies ,business.industry ,Endovascular Procedures ,Significant difference ,Treatment options ,Intracranial Aneurysm ,Recovery of Function ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
BackgroundThere is no consensus regarding the best treatment option for unruptured aneurysms of the posterior communicating artery (PCom) presenting with oculomotor nerve palsy (ONP). We aimed to assess predictors of ONP recovery in a multicenter series of consecutive patients.Materials and methodsA retrospective review of prospective databases in three tertiary neurosurgical centers was carried out, selecting patients with ONP caused by unruptured PCom aneurysms, treated by surgical clipping or embolization, between January 2006 and December 2013. Patient files and imaging studies were used to extract ophthalmological assessments, treatment outcomes, and follow-up data. Predictors of ONP recovery during follow-up were explored using univariate and multivariate analyses.ResultsWe identified 55 patients with a median ONP duration before treatment of 11 days (IQR 4.5–18); the deficit was complete in 27 (49.1%) and incomplete in 28 (50.9%) cases. Median aneurysm size was 7 mm (IQR 5–9). Twenty-four (43.6%) patients underwent surgical clipping and 31 (56.4%) embolization as the primary treatment. Overall, ONP improved in 40 (72.7%) patients and persisted/recurred in 15 (27.3 %). Surgery, interval to complete treatment ConclusionThere was no significant difference in ONP recovery between surgical clipping and embolization. The best predictor for ONP recovery was timely, complete, and durable aneurysm exclusion.
- Published
- 2020
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